Laws invariably impact scope of care and scope of practice. Many scope of care-related laws are designed to protect the interest of patients and/or consumers. Similar to jurisdiction debates in law enforcement, scope of care issues in healthcare highlight the ways each professional dimension or area of specialization is bounded by "turf battles," even when those battles may adversely impact quality of care (National Council of State Boards of Nursing, 2009). Complicating the matter are recent developments in healthcare law, which constrain unethical practices but which might also inadvertently impinge upon legitimate healthcare work. Scope of practice changes should ideally reflect evidence-based practice.
Often the primary beneficiary of scope of care laws are institutions, which avoid needless lawsuits. Primary care services that change as the result of scope of practice legal changes may have positive economic impacts on healthcare institutions. On the other hand, laws that unnecessarily prevent quality of care delivery due to arbitrary restrictions on primary care providers can cause delays in treatment and even medical errors. Scope of practice issues can also be framed in terms of economic need and viability of institutions to provide for the needs of their patients (National Council of State Boards of Nursing (2009).
Scope of practice laws should at the very least require demonstration of professional capacity to treat patients in certain key areas. In emergency situations, scope of care issues may be more flexible than in non-acute care settings. Moreover, healthcare providers working with a team of professionals have the additional capability of poling knowledge and resources throughout the caregiving process. This would theoretically allow for some healthcare professionals to assume the duties of colleagues, so long as primary care physicians authorize the additional and collaborative treatment. Therefore, scope of practice changes in the law generally lower cost of services while serving the public good, so long as evidence-based practice methods are employed.
2. The Patient Protection and Affordable Care Act (ACA) and its amendments generally did not affect TRICARE, the Department of Defense program, or to Department of Veterans Affairs services. However, there have been some ambiguities in the ACA that warrant clarification. The TRICARE Affirmation Act generally took care of the more obvious inconsistencies in the ACA, especially with regards to showing that TRICARE itself fulfills the "mandatory" minimum essential healthcare coverage as per the ACA. Similarly, ancillary veterans-related healthcare programs such as the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) meet the general ACA requirements. Provisions for the children and dependents of veterans is also accounted for in acts like the CHAMPVA Children's Protection Act.
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